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EMERGENCY EVALUATION OF IMPORTANT OCULAR SYMPTOMS

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EVALUATION OF THE RED OR PAINFUL EYE

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HISTORY & EXAMINATION

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Historical factors are important to determine the cause of ocular complaints in the pediatric patient. History, when correlated with characteristic ocular findings on focused physical examination, often makes the diagnosis. History includes a child’s activity and behavior, and the usual historical items, including previous episodes, onset of symptoms, contact lens use, concurrent illnesses or complaints, and associated symptoms (Table 32–1) (Figures 32–1, 32–2).

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Table 32–1.Causes of unilateral red or painful eye.
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Figure 32–1.

Red or painful eye. Reproduced, with permission, from Stone CK, Humphries RL: Current Diagnosis & Treatment Emergency Medicine, 7th ed. New York: McGraw-Hill, 2011. Copyright © McGraw-Hill Education LLC.

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Figure 32–2.

Differential diagnosis for the painless red eye with discharge.

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Complete eye examination includes the following components, which need to be tailored to the age and capabilities of each patient

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Visual Acuity
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Visual acuity testing of the neonate, infant, or toddler is performed by testing the pupillary reaction to light. The ability of the child to track and fixate on a light source 1-3 feet away determines adequate visual acuity. Steady fixation roughly indicates 20/40, unsteady fixation 20/100, and inability to fixate 20/400. Formal visual acuity testing of a child 2-3 years of age is performed by means of a Snellen chart, Allen chart, or rotating “E” ...

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